[Applause] [Music] there are two types of COPD empyema and chronic bronchitis commonly called the pink puffer and blue bloater now most enlex questions don't really focus on the patho here but it may come up on your nursing exams so again think C in COPD as C for chronic air trapping and lung hyperinflation because air cannot get out of the lungs so for empyema or pink puffer these clients are typically well profused they're pink but they have difficulty breathing so just think puffer this results from damage to the alvioli which results in loss of lung elasticity and loss of inflation of lung tissue due to the loss of surfactant that helps the lungs stretch so we get a loss of lung tissue recoil and end up with air trapping inside the lungs and on the other side for chronic bronchitis think blue bloater because they are usually cyanotic which turns them blue and this happens due to inflammation of the broni that smooth muscle hypertrophy and contraction within the broni itself as well as excessive mucous production resulting in a chronic hacking cough and reoccurring infections now in terms of signs and symptoms for empyema think pink puffer so we use the acronym pink P for pink skin and Pur lip breathing the very earliest sign is that they are huffing and puffing so just think puffed out cheeks and pursed lips for pink puffer I is for increased chest known as a barrel chest n is for no chronic cough or very minimal cough and K is for they keep on tripoding to get air Exchange check out our brand new app and get access to our new pharmacology and Med surge Mastery courses plus 11 other courses like fundamentals Pediatrics maternity mental health and more complete with over 300 follow-along cheat sheets and a massive quiz Bank loaded with detailed ration to test your knowledge join for free click the link in our description below so Kaplan mentions a client with empyema you'll find hyperresonance when percussive ing the lungs so yes think high air trapping for hyperresonance there and on the other side for chronic bronchitis we get that blue bloater so just use the acronym blue b for big and blue skin known as sinosis this is hypoxia so just think big and blue typically our patients are obese and have a blue body L is for long-term chronic cough and sputum which cough is the earliest indicator for chronic bronchitis U is for unusual lung sounds we typically hear crackles and wheezes and E is for edema that shows up peripherally due to that core pulmonale that right-sided heart failure now this happens as the right side of the heart is having great difficulty pumping blood into these really hard fibrotic lungs eventually this leads to pulmonary hypertension as blood backs up into that right ventricle and then into the entire body making the body big bloated and swollen hence the name blue bloater so the memory trick just think of R for right-sided heart failure as R for rocks the body with fluid the Key signs is edema jvd and weight gain and a little side note here for weight gain just think water gain as the body gets rocked with fluid from this right-sided heart failure now in terms of of vital signs the big key Point here is that decreased oxygen saturation levels are normal and to be expected so a pul Sox in the low 90% range is normal for patients with COPD so 88 to 93% is typically the normal range for all clients in worsening or endstage COPD so don't freak out and think that it has to be between 95 to 100% and another classic sign is clubbing fingers specifically with clients with [Music] empyema no not those clubbing fingers these clubbing fingers we see round nail beds that sort of look round at the tips here so this is a common sign of long-term chronic hypoxia and next thanks for watching for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our YouTube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time [Music]